Increased spending on primary, community, and long-term health and social care will be required as costs rise and the population grows and ages

New research from the ESRI funded by the Department of Health projects expenditure for most primary, community, and long-term health and social care services in Ireland for the years 2019–2035. These projections take into account new ESRI population and macroeconomic projections that incorporate the expected impact of COVID-19. Expenditure projections incorporate a range of scenarios for changes in demographics, healthy ageing, policy measures, and costs.

Main findings

The main findings of “Projections of Expenditure for Primary, Community and Long-Term Care in Ireland, 2019–2035, based on the Hippocrates Model” are:

• The cost of delivering care, particularly pay-related costs, is the main driver of expenditure growth for health and social care services.
• Of the services considered, the largest increases in expenditure are projected to be for high-tech medicines dispensed in the community, long-term residential care and home support services.
• We project nominal expenditure requirements for:
  • public and private general practice of between €1.6bn and €2bn in 2035. This implies a 2.9 per cent - 4.5 per cent average annual expenditure increase. Increases in the cost of providing care is the largest driver of projected expenditure growth.
  • high-tech medicines of between €2.3bn and €4.4bn in 2035. This implies a 6.1 per cent - 10.5 per cent average annual increase and reflects a continuation of high recent growth in demand for high-tech medicines.
  • public and private long-term residential care of between €3.8bn and €5.7bn in 2035. This implies a 4.3 per cent - 6.9 per cent average annual expenditure increase. Population ageing is the key driver of projected expenditure increases for this service.
  • public and private home support of between €1.2bn and €3.0bn in 2035. This implies a 4.4 per cent - 10.4 per cent average annual increase. Likely increases in demand following the establishment of a statutory home support scheme is the key driver of projected expenditure growth.

Policy Recommendations

Due to a combination of a growing and ageing population and increasing costs of care delivery, particularly relating to pay, expenditure on non-hospital health and social care is projected to increase substantially by 2035. The findings provide an evidence base for workforce and capacity planning and for the implementation of important Sláintecare proposals. Identifying approaches to address the projected increases in the cost of care delivery should be an important consideration for policymakers.

The scope of the analysis was hampered by the poor data available for many services. Policymakers should prioritise development of a health data infrastructure that caters for the requirements of both local and national-level service planners.

One of the authors of the report, Brendan Walsh stated: "This report highlights that substantial investment in primary, community and long-term healthcare will be required in the coming years. The results provide policymakers with evidence on what funding pressures are likely to arise in different parts of the system. We find that continuing current trends will lead to expenditure growth on high-tech medicines and long-term residential care that far exceeds that of general practice and home support in the medium term. This information should help policymakers frame decisions about what parts of the system should be prioritised for investment and where to focus policies to contain cost pressures.”